Running head: POPULATION RISK

POPULATION RISK

Ashlee Knoll

NURS 340

January 29, 2018

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POPULATION RISK
Population Risk

Every community has populations within them that are more vulnerable than others.

Vulnerability can be exacerbated by factors such as age, resources, location, insurance coverage,

and transportation. The elderly and children are always considered a highly vulnerable

population strictly based on age and immature immune systems in children or weakened immune

systems in the elderly. During this paper, I will be reviewing the factors that specifically place

the elderly population at a higher health risk than others.

Elderly Populations

Elderly people reside in a wide variety of communities and they are not typically

confined to one area together outside of retirement, or assisted living areas. The risks associated

with living in rural areas are higher as there are increased barriers to provide appropriate

healthcare. The windshield survey that was completed and documented in Appendix A outlines

some of the struggles living in a rural area such as Merrill, MI can create for not just the elderly,

but all that choose to live in these areas. Harkness and DeMarco (2016) identify the seven A’s of

Challenges to Elders in Rural Areas:

1. Availability: Insufficient number and diversity of formal services and providers; lack of

acceptable service and human service infrastructure

2. Accessibility: Shortages of adequate, appropriate, and affordable transportation; cultural

and geographic isolation

3. Affordability: Poverty and inability to pay for services

4. Awareness: Low levels of information dissemination; literacy issues

5. Adequacy: Lack of service standards and evaluation; evidence-based practice

compromised
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6. Acceptability: Reluctance to ask for help

7. Assessment: Lack of basic information on what is needed using research rigor and

analysis

These challenges make the elderly in rural areas especially more vulnerable. As a person ages,

they are faced with the consequences of health choices that they may have made earlier in life.

This results in elderly populations developing chronic pathologies, which frequently interact with

the aging process itself further complicating health. Santangelo and Maugeri (2011) explain that

the physiological aging is characterized by a gradual and continuous loss of functional abilities,

involving the whole body, without any serious disequilibria between various organs, and without

the signs of any evident pathologies. Throughout history, people have been faced with different

disease processes that have jeopardized mankind even before getting old. Through advances in

medicine and bodies that have become more adaptable, people are living longer creating new

challenges regarding the care of people that have developed several disease processes

(Santangelo et al., 2011). There are also certain races and ethnicities that are predisposed to

certain diseases that regardless of preventative maintenance and access to healthcare, the risk

remains higher. Stereotypes that are placed on the elderly population can also hinder their ability

to age seamlessly. Dionigi (2015) discusses research completed by Levy and colleagues to

determine if everyday encounters with negative stereotypes across a lifetime are associated with

cognitive outcomes. What they found was that individuals with more negative age stereotypes

showed significantly worse memory performance compared to those with a less negative age

stereotype. Therefore as healthcare providers, it is important to maintain a positive outlook and

not play into negative stereotypes of any age group.

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Demographics

As stated above, the number of elderly people around the world is growing based on the

medical advances and increased adaptability of the body. Based on information obtained in

Appendix A regarding the population demographics of Merrill, MI 25.6% of the population was

between the age of 45 to 64 years old and 17.1% were 65 years of age or older. Within the state

of Michigan, populations have been trending upwards since 1990 with the number of those older

than 65 years jumping from 1,570,549 in 2015 to 1,611,755 in 2016. Since 1990, both males and

females have continued to exceed the age of 65 years old within every race as well including

White, Black, Native American, and Asian. According to the Population Reference Bureau

(2018), the number of Americans ages 65 and older is projected to more than double from 46

million today to over 98 million by 2060, and the 65-and-older age group’s share of the total

population will rise to nearly 24% from 15%. The average life expectancy has increased from 68

years in 1950 to 79 years in 2013, due to the reduction in mortality at older ages. These changes

will impact the way that healthcare can be provided, increasing the need for primary care

providers to care for patients across the life span by increasing the need for nursing home care.

Other things to consider with an aging population is the fact that there are more older adults that

re divorced when compared to previous generations leading to more elderly people living alone.

The projected increased life span will also increase the number of those accessing benefits such

as social security and Medicare, increasing the gross domestic product from eight percent to

twelve percent by the year 2050 (Mather, 2018). The United Nations projects global population

to grow from about seven billion today to 9.3 billion in 2050 (Lee, 2011).
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Health Concerns

As people continue to age and are impacted by the environment around them, disease

processes continue to become more prevalent within the population. Heart disease, diabetes,

kidney failure, and COPD are all diseases that are impacted by lifestyle but increased age tends

to wear out these organs as well. As a person ages, the risk for fall also increases in relation to

acute and chronic illness, medications, as a prodrome to other diseases, or as idiopathic

phenomena (Hendrich, 2016). Often times, the risk for fall and injury related to falls is directly

proportionate with the number of pre-existing conditions. Once a person sustains a serious fall

resulting in a fracture, the increase risk of death increases significantly.

Another risk associated with an aging population is the use of multiple drugs to treat the

different ailments that develop over time. Often times, the elderly will have multiple physicians

that they see for different issues. The primary care provider can hopefully assist with keeping

their different medications straight and preventing any adverse drug interactions. Patients of any

age have to be properly educated regarding the use of medications as well. Often people feel that

they don't need to continue a medication because they are feeling better, or because their blood

pressure has improved. Checking for understanding and continued follow up can contribute to

safe medication usage for patients. As healthcare coverage changes and government mandates

are made, it may affect the ability of these patients to receive their prescriptions making

compliance to treatment more difficult.

Osteoporosis

A prevalent disease process that plagues the elderly population is the diagnosis of

osteoporosis. Osteoporosis occurs when the small space within a healthy bone begins to increase

in size causing loss in strength and density making the bone weak and thin. As the population
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ages, the overall risk of fractures increases, thus burdening the health care system (Lagari,

Gavcovich, and Levis, 2018). One of the struggles physicians are facing to treat osteoporosis is

the stigma associated with the side effects of the medications that can be used to prevent the

further loss of bone density. Lagari, Gavcovich, and Levis (2018) also explain that a major

hindrance to the treatment of osteoporosis is lack of recognition and appropriate screening.

Currently, bone mineral density testing by dual x-ray absorptiometry (DXA) is the international

standard for the assessment of bone health and diagnosis of osteoporosis. Increased screening

and prevention could be implemented to assist with the health care delivery to patients. Nursing

can continue to impact this population by obtaining thorough health histories including

medication review and history and initiating screening opportunities to further patients education

regarding their risks.

Conclusion

Overall, the elderly population continues to be at risk in relation to an expanded life

expectancy in relation to previous years. I discussed how location, along with other factors,

increase vulnerability among the elderly population. The demographics regarding local, state

and national levels of the elderly population were reviewed as well as the projected outlook

regarding the aging population. Health concerns and disease processes, including osteoporosis,

were overviewed with possible interventions applied to keep the risk factors minimized and

promote a healthy lifestyle.


POPULATION RISK
Boundaries
Are the boundaries geographical, political, proximitiy. Along M-46 going east and west, Merrill has a
or economic?
Do neighborhoods have names?
Are there sub-communities?
How are these identified?
Housing and Zoning
What is the age of the buildings? Are the the homes in the mid 1900s. Most homes are single family within
residences single family or multifamily
dwellings?
Signs of Decay
Is the area well maintained or in disrepair? there are seasonal decorations applied including flowers planted in
Is there garbage strewn? Are there
trashed/abandoned cars, places for rodents majority are very well kept homes.
or other wildlife to hide, vacant lots?
Parks and Recreational Areas
Are there play areas for children and
adults? Are they safe and maintained? Is
there a Community Center? Who uses
them?
Common Areas
Where do people collect for social
gatherings; where do they “hang out”?
Are they for particular groups or are they
open to all? Are there signs posted?
Stores
What stores (grocery, retail, drug, dry
cleaning, etc.) are in the area? How do
residents travel to them?
Transportation
How do most people get around the area?
Is there public transportation? If so what
kind and does it appear to be used? Who
uses it? What is the condition of the
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Appendix A
Windshield Survey
Merrill is located along M-46 with sevreral towns witin close
“Welcome to the Village of Merrill” sign posted, when going out
of town, north or south, it is identified by an increasing speed limit
as you exit town.
The villiage has no sub-communities within, but the community
stretches further north to include Jam, MI and south to Marion
Springs, MI. Neither of which have a zip code.
The village has a total area of 0.70 square miles.
Majority of the buildings were built in the early 1900s and most of
the village with some appartments avaliable above the older
buildings within town.
The village is well maintained by the community. It is clean and
the spring/summer. Some of the homes are in need of repair but
There are no vacant lots creating a place for trash to accumulate.
There is a community park including 3 baseball fields for youth
and slowpitch games. There is also another smaller field for tball
and youth softball games near the Sacred Heart Church.
Gatherings occur at the three restaurants present in the village.
There are two bar and grills (Ejs and Woody’s), as well as a Tonys
restaurant. These are open to all including families. During the
summer months, the Merrill Dairy Bar is open for business and is
where many families gather after sporting events and other
community activities.
There is not a grocery store within the village of Merrill. The
closest (small) grocery store is in Hemlock (5 miles away from
downtown). Most people travel by car to Meijer in Shields which
is 15 miles away. There is a Dollar General avaliable within town
that some groceries and other supplies can be found. The Express
Stop gas station does keep common necessesities such as milk
avaliable. There is a beauty salon, furniture store, insurance
agency, video rental store, funeral home, crematory/vault
company, embroidery shop, quilt shop, machine shop, used car
dealership/body shop, and Merrill Tool and Machine.
There is no public transportation avaliable within Merrill. Almost
every person obtains their licence at 16 years old out of necessity.
People rely, even in town, on personal vehicles to travel and
therefore maintain some form of reliable vehicle.
The roads throughout all of Saginaw County are very rough with

POPULATION RISK
streets, roads, highways?
Communication
Is there evidence of local and national
newspapers to other media? Are there
informational posters on streets, busses,
billboards, etc.?
Service Centers
What services are available in the
community – health care, social services,
schools, employment offices etc.?
People in the Community
Who is in the area during the day? What
evidence is thereof particular “classes” of
people – upper, middle, working, lower?
Industries
What are the major industries located in
the area? What types of occupations are
evident?
Protective Services
Where are fire and police stations located?
Is there evidence of police and fire
protection in the area?
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pot holes and cracks present. This is true within Merrill as well.
M-46 is the main highway that goes through town and it fairly well
maintained by the County.
There are no buses or billboards posting any information within
the town. The only form of public communication is at the bank
where community events and times are posted. Flyers are posted
within the community businesses as well.
Preschool thru 12th grade are offered at Merrill Community
Schools. Class sizes are small with dual enrollment opportunities
offered in middle and high school.
There is a dentist office located within town but no other
healthcare services are avaliable.
A library is also located downtown that offers free internet for
those that are in need.
There were 295 households of which 35.6% had children under the
age of 18 living with them, 51.2% were married couples living
together, 13.9% had a female householder with no husband
present, 5.8% had a male householder with no wife present, and
29.2% were non-families. 25.4% of all households were made up
of individuals and 12.6% had someone living alone who was 65
years of age or older. The average household size was 2.60 and the
average family size was 3.02.
The median age in the village was 39.5 years. 24.6% of residents
were under the age of 18; 9% were between the ages of 18 and 24;
23.8% were from 25 to 44; 25.6% were from 45 to 64; and 17.1%
were 65 years of age or older. The gender makeup of the village
was 48.3% male and 51.7% female.
The median income for a household in the village was $36,167,
and the median income for a family was $40,278. Males had a
median income of $35,469 versus $29,028 for females. The per
capita income for the village was $19,312. About 5.4% of families
and 8.0% of the population were below the poverty line, including
8.8% of those under age 18 and 10.3% of those age 65 or over
(Village of Merrill, 2018).
Most people commute outside of the community, but farming is
the largest industry within town. Merrill Tool and Machine is
avalibale to serve many diciplines around the country including
aerospace, chemical processing, defense, energy, oil & gas,
nuclear, mining and heavy equipment, robotics and machined tools
(Merrill Technologies Group, 2018).
Police protection is provided through a contract with the Saginaw
County Sheriff’s Department. Business phone 643-7049. ALL
EMERGENCY CALLS, PHONE 911.
Fire/Rescue is provided through the Jonesfield/Lakefield Fire
Department located on W. Mahoney Street. Business phone 643-
5277. ALL EMERGENCY CALLS, PHONE 911 (Village of
Merrill, 2018).

POPULATION RISK
Ethnicity
What is the predominant ethnic group?
Are there residents from a variety of
ethnic backgrounds or is the community
mostly one group? Which one? Are there
stores, restaurants, churches, schools, or
languages that indicate a particular ethnic
group(s)?
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As of the census of 2010, there were 778 people, 295 households,
and 209 families residing in the village. The racial makeup of the
village was 95.0% White, 1.2% African American, 0.5% Native
American, 0.3% Asian, 1.8% from other races, and 1.3% from two
or more races. Hispanic or Latino of any race were 6.7% of the
population (Village of Merrill, 2018).

Religion The Village has two churches, both located on Midland

What churches and church-run schools are Street. Merrill Congregational Church and Sacred Heart
in the area (denomination)? How many (Catholic) Church.
are there of each denomination?

Health and Morbity
Is there evidence of any health problems
such as drug/alcohol abuse,
communicable or chronic diseases, mental
illness (etc)?
Politics
Is there evidence of political activity? Are
there any signs that indicate a
predominant political party (parties)or
concern(s)?
According to Sperling’s BestPlaces (2018), Merrill has a 84/100
air quality rating and a water quality rating of 26/100 with
municiple water being piped in less than 10 years ago.
55.46% of the people in Merrill, Michigan are registered as
Democrats. 43.56% are registered Republican. Remaining are
independent: 0.98% (Sperling’s BestPlaces, 2018).

Windshield Survey Summary

Community is a term that can be used to define relationships and surroundings through

all aspects of a persons life including family, neighborhoods, schools, or even at work.

Community is defined as a group of people sharing common interests, needs, resourses and

enviornment (Harkness & DeMarco, 2016). Community health definitions have been altered to

fit the public health field but Goodman and Posner (2014) define it as the health status of a

defined group of people and the actions and conditions, both private and public (governmental),

to promote, protect, and preserve their health. The entire community and the needs that are

present can be evaluated and collaborative efforts can be made to overall improve the health of

the community as client.

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Merrill, like every community, has potential health risks present that could become

harmful to the population. A major risk is the avaliable access to a hospital or emergency room.

Merrill is located at least 45 minutes from any emergency room creating a large risk for patients

that are sufferng from events such as stroke, heart attack, or victims of accidents (motor vehicle,

farming, or recreational). The community is also faced with the risk of a sedentary lifestyle as

distance again restricts the ability to utilize healthy forms of transportation such as walking or

bike riding. This sedentary lifestyle can lead to heart disease or diabetes. With the main form of

transportation for the community being cars, they are also at higher risk to be in an accident as

majority of the population are forced to commute both within and beyond the community.

Another possible risk within Merrill is the lack of a local grocery store forcing the people to

either drive to obtain supplies to make a healthy dinner, or for convience, they resort to ordering

out from the local restaurants that do not offer a multitude of healty options.

Healthy People 2020 identifies several different objectives with goals to achieve for

overall public health. The health indicator of Access to Health Services is a serious inititve that

can be addressed in Merrill. Nurses can contribue to the success of this by encouraging

preventative care and promote education so the need for emergency care can hopefully be

minimized. Several healthcare facilities have began practices to reach rural areas as well as

increase access to healthcare services by providing remote tele medicine opportunities via the

internet. These alternative methods have the potential to reach thousands of patients seeking

healthcare including the community of Merrill.

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References

Dionigi, R. A. (2015, August). Stereotypes of Aging: Their Effects on the Health of Older

Adults. Journal of Geriatrics, 2015. doi:dx.doi.org/10.1155/2015/954027

Goodman, R. A., Bunnell, R., & Posner, S. F. (2014, October). What is “community health”?

Examining the meaning of an evolving field in public health. Preventive Medicine, 67(1),

S58-S61. doi:10.1016

Harkness, G. A., & DeMarco, R. F. (2016). Community and Public Health Nursing (2nd ed., pp.

364-370). Philadelphia, PA: Wolters Kluwer.

Hendrich, A. (2016). Fall Risk Assessment for Older Adults: The Hendrich II Fall Risk Model

[Electronic version]. Try This: Best Practices in Nursing Care to Older Adults.

Lagari, V., Gavcovich, T., & Levis, S. (2018, January). The Good and the Bad About the 2017

American College of Physicians Osteoporosis Guidelines. Clinical Therapeutics, 40(1),

168-176. doi:doi.org/10.1016/j.clinthera.2017.11.008

Lee, R. (2011, July 29). The Outlook for Population Growth [Electronic version]. Science,

333(6042), 569-573.

Mather, M. (2018). Fact Sheet: Aging in the United States. In Population Reference Bureau .

Retrieved from http://www.prb.org/Publications/Media-Guides/2016/aging-unitedstates-

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Merrill Technologies Group. (2018). Industries . In Merrill Tool and Machine . Retrieved from

http://merrilltool.com/industries

Santangelo, A., Albani, S., Beretta, M., Capello, A., Mamazza, G., Pavano, S., & Testai, M.
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(2011, March). Aging and environmental factors: An estimation of the health state of the

elderly population residing in industrialized vs. rural areas. Archives of Gerontology and

Geriatrics, 52(2), 181-184. doi:doi.org/10.1016/j.archger.2010.03.014

Sperling's BestPlaces. (2018). People . In Merrill Michigan. Retrieved from

https://www.bestplaces.net/people/city/michigan/merrill

State of Michigan. (2018, August). Michigan Population, 1990-2016. In Michigan Department of

Health and Human Services. Retrieved from http://www.michigan.gov/mdhhs/

Village of Merrill . (2018). General Information . In Welcome to the Village of Merrill. Retrieved

from http://www.merrillvillage.com/about/general-information/